2026 Patch Test

For children who pass the test, the guard should complete the form and have parents sign the permission section.

"*" indicates required fields

Date of Patch Test

Test Requirements 1) Swim the length of the pool with a competent stroke; 2) Tread water for one minute; and 3) Float on their back for 15 seconds.

DLSC Number*

Membership, summer rental or August Guest pass number

Please enter a number from 1 to 900.

Child's Name*

Name of Child who passed the Test

First Last

Date of Birth*

Parent's Name*

First Last

Email*

Phone*

Parent's Signature

Manager who oversaw the Patch Test*

First Last

Guard who gave the Patch Test*

First Last

Guard's Signature

Order Token